scholarly journals Patient-Tailored Aortic Valve Replacement

2021 ◽  
Vol 8 ◽  
Author(s):  
Ole De Backer ◽  
Ivan Wong ◽  
Ben Wilkins ◽  
Christian Lildal Carranza ◽  
Lars Søndergaard
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Aortic Valve Disease ◽  
Valve Disease ◽  
Surgical Aortic Valve Replacement ◽  
Patient Centered ◽  
Surgical Risk ◽  
Transcatheter Aortic Valve

Contemporary surgical and transcatheter aortic valve interventions offer effective therapy for a broad range of patients with severe symptomatic aortic valve disease. Both approaches have seen significant advances in recent years. Guidelines have previously emphasized ‘surgical risk’ in the decision between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR), although this delineation becomes increasingly obsolete with more evidence on the effectiveness of TAVR in low surgical risk candidates. More importantly, decisions in tailoring aortic valve interventions should be patient-centered, accounting not only for operative risk, but also anatomy, lifetime management and specific co-morbidities. Aspects to be considered in a patient-tailored aortic valve intervention are discussed in this article.

scholarly journals OUTCOMES OF MIXED AORTIC VALVE DISEASE IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT

2021 ◽  
Vol 77 (18) ◽  
pp. 1394
Author(s):  
Srilakshmi Vallabhaneni ◽  
Marsel Matka ◽  
Stephen Olenchock ◽  
Raymond Durkin ◽  
Christopher Sarnoski ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Aortic Valve Disease ◽  
Valve Disease ◽  
Transcatheter Aortic Valve

scholarly journals Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Disease

2014 ◽  
Vol 64 (22) ◽  
pp. 2330-2339 ◽  
Author(s):  
Darren Mylotte ◽  
Thierry Lefevre ◽  
Lars Søndergaard ◽  
Yusuke Watanabe ◽  
Thomas Modine ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Bicuspid Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Aortic Valve Disease ◽  
Valve Disease ◽  
Transcatheter Aortic Valve

scholarly journals Patient-centered benefit-risk analysis of transcatheter aortic valve replacement

F1000Research ◽  
2021 ◽  
Vol 8 ◽  
pp. 394
Author(s):  
Kevin Marsh ◽  
Natalia Hawken ◽  
Ella Brookes ◽  
Carrie Kuehn ◽  
Barry Liden
Keyword(s):  
Aortic Valve ◽  
Risk Analysis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Pairwise Comparison ◽  
Surgical Aortic Valve Replacement ◽  
Patient Centered ◽  
Transcatheter Aortic Valve ◽  
Trade Offs

Background: Aortic stenosis (AS) treatments include surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). Choosing between SAVR and TAVR requires patients to trade-off  benefits and risks. The objective of this research was to determine which  TAVR and SAVR outcomes patients consider important, collect quantitative data about how patients weigh benefits and risks, and evaluate patients’ preferences for SAVR or TAVR. Methods: Patients  were recruited from advocacy organization databases. Patients self-reported as being diagnosed with AS, and as either having received AS treatment or as experiencing AS-related physical activity limitations. An online adapted swing weighting (ASW) method – a pairwise comparison of attributes – was used to elicit attribute trade-offs from 219 patients. Survey data were used to estimate patients’ weights for AS treatment attributes, which were incorporated into a quantitative benefit-risk analysis (BRA) to evaluate patients’ preferences for TAVR and SAVR. Results: On average, patients put greater value on attributes that favored TAVR than SAVR. Patients’ valuation of the lower mortality rate, reduced procedural invasiveness, and quicker time to return to normal quality of life associated with TAVR, offset their valuation of the time over which SAVR has been proven to work. There was substantial heterogeneity in patients’ preferences. This was partly explained by age, with differences in preference observed between patients <60 years to those ≥60 years. A Monte Carlo Simulation found that 79.5% of patients prefer TAVR. Conclusions: Most AS patients are willing to tolerate sizable increases in clinical risk in exchange for the benefits of TAVR, resulting in a large proportion of patients preferring TAVR to SAVR. Further work should be undertaken to characterize the heterogeneity in preferences for AS treatment attributes. Shared decision-making tools based on attributes important to patients can support patients’ selection of the procedure that best meets their needs.

scholarly journals Patient-centered benefit-risk analysis of transcatheter aortic valve replacement

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 394 ◽  
Author(s):  
Kevin Marsh ◽  
Natalia Hawken ◽  
Ella Brookes ◽  
Carrie Kuehn ◽  
Barry Liden
Keyword(s):  
Aortic Valve ◽  
Risk Analysis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Pairwise Comparison ◽  
Surgical Aortic Valve Replacement ◽  
Patient Centered ◽  
Transcatheter Aortic Valve ◽  
Ofthe Time

Background: Aortic stenosis (AS) treatments include surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). Choosing between SAVR and TAVR requires patients to trade-off  benefits and risks. The objective of this research was to determine which  TAVR and SAVR outcomes patients consider important, collect quantitative data about how patients weigh benefits and risks, and evaluate patients’ preferences for SAVR or TAVR. Methods: Patients  were recruited from advocacy organization databases. Patients self-reported as being diagnosed with AS, and as either having received AS treatment or as experiencing AS-related physical activity limitations. An online adapted swing weighting (ASW) method – a pairwise comparison of attributes – was used to elicit attribute tradeoffs from 93 patients. Survey data were used to estimate patients’ weights for AS treatment attributes, which were incorporated into a quantitative benefit-risk analysis (BRA) to evaluate patients’ preferences for TAVR and SAVR. Results: On average, patients put greater value on attributes that favored TAVR than SAVR. Patients’ valuation of the lower mortality rate, reduced procedural invasiveness, and quicker time to return to normal quality of life associated with TAVR, offset their valuation ofthe time over which SAVR has been proven to work. There was substantial heterogeneity in patients’ preferences. This was partly explained by age, with differences in preference observed between patients <60 years to those ≥60 years. A Monte Carlo Simulation found that 75.1% of patients prefer TAVR. Conclusions: Most AS patients are willing to tolerate sizable increases in clinical risk in exchange for the benefits of TAVR, resulting in a large proportion of patients preferring TAVR to SAVR. Further work should be undertaken to characterize the heterogeneity in preferences for AS treatment attributes. Shared decision-making tools based on attributes important to patients can support patients’ selection of the procedure that best meets their needs.

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